Abstract
Post-kala-azar dermal leishmaniasis (PKDL) is a dermatologic manifestation that usually occurs after visceral leishmaniasis (VL) caused by Leishmania donovani. It is characterized by hypopigmented patches, a macular or maculopapular rash and nodular skin lesions on the body surface. Involvement of the mucosae is very rare and unusual in PKDL. We report a case of PKDL that presented with polymorphic skin lesions, along with involvement of peri-oral mucosa and tongue from an endemic area for kala-azar in Bangladesh. In the absence of a definite past history of kala-azar, a clinical suspicion for PKDL was confirmed by positive rapid serological tests against two recombinant (rK39 and rK28) leishmanial antigens, demonstration of Leishmania donovani (LD) body in the slit skin smear, and isolation of promastigotes by culture from a nodular lesion. The patient was treated with oral Miltefosine for three consecutive months and showed significant clinical improvement as demonstrated by a negative slit skin smear at two months after initiation of therapy. We report this case as an unusual presentation of mucosal involvement in PKDL and subsequent treatment success with Miltefosine.
Highlights
Post-kala-azar dermal leishmanisis (PKDL), first described by Brahmachari in 1922, is a dermatologic manifestation which usually occurs months to years after resolution of visceral leishmaniasis (VL) caused by Leishmania donovani [1]
PKDL has been reported in individuals without a prior history of VL, suggesting subclinical infection [2]
Unlike kala-azar which is fatal without treatment, PKDL is not usually associated with systemic illness but it is speculated that patients can remain infectious for years or even decades [6]
Summary
Post-kala-azar dermal leishmanisis (PKDL), first described by Brahmachari in 1922, is a dermatologic manifestation which usually occurs months to years after resolution of visceral leishmaniasis (VL) caused by Leishmania donovani [1]. A 40-year old day-labourer (male) from Godagari subdistrict, a kala-azar-endemic area of Rajshahi district, Bangladesh, presented with graduallydeveloping hypopigmented patches over different parts of the body for 12-15 years, followed by erythematous papular and nodular lesions over the face, neck, and trunk for the last 8-10 years, along with concomitant involvement of peri-oral mucosa and tongue (Figure 1a and 1b). Associated complaints included change of voice and intermittent difficulty in swallowing for the same duration He attended the outpatient Dermatology Department of Rajshahi Medical College Hospital (RMCH) and was suspected clinically to be a case of post-kala-azar dermal leishmaniasis (PKDL). The patient reported fever of about three months duration when he was 9 years old but there was no history of VL diagnosis nor treatment with injectable drugs for that fever He did not give any family history of kala-azar.
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